THE HEALTH CARE DEBATE: BEHIND THE SCENES

By TODD S. PURDUM

Published: July 1, 1994

WASHINGTON, June 30—
In her 14 years in Congress from Hartford, a district where 50,000 people work in insurance, Representative Barbara B. Kennelly of Connecticut has always known how tempting it would be for her colleagues to typecast her as the Congresswoman from Aetna.

So she has worked hard as a member of the Ways and Means Committee to involve herself in other issues, like overhauling welfare, compiling statistics on people attacked in hate crimes and increasing access to mammograms for older women. And she has chosen her shots carefully.

The work has paid off: She has as safe a seat as any member, is one of four chief deputy majority whips and is the highest-ranking woman in the House.

But as the committee groped its way through long caucuses and late-night debates toward passage of a health care bill this week, Mrs. Kennelly personified the painful choices faced by House Democrats. She has voted time after time -- giving her final aye today -- for sweeping health insurance changes that are not only guaranteed to anger many of her constituents but are also far from certain to pass in the full House, let alone the more conservative Senate.

'Best Judgments'

"I've spent a great deal of time knowing that I could be looked at as a member of Congress with only one issue," Mrs. Kennelly (pronounced kuh-NELL-ee) said Wednesday in a few stolen moments in the Ways and Means library. "I wasn't going to have people saying, on the biggest bill, 'All of a sudden, she won't give. She's going to stand in cement because this is what they want.' " She acknowledged that some people would be annoyed, but said, "What you try to do is give your best judgments."

Mrs. Kennelly's goal has been to reconcile her longstanding belief in the need for universal health coverage with her desire to preserve an active private insurance industry.

This week, her best judgments included helping to broker a compromise that would delay until at least the year 2001 the imposition of Federal price controls on health care if states exceeded spending limits. The committee's acting chairman, Sam M. Gibbons of Florida, had proposed that the fee schedules take effect in 1999, but Mrs. Kennelly and others wanted to give private competition more time to bring costs under control.

"She's not in the leadership by accident," said Liz Robbins, a lobbyist whose clients have included social welfare and health agencies in New York State and New York City. "People look to Barbara on this stuff. You can count on her to know her stuff and not flinch."

Mrs. Kennelly's vote was important because the committee Republicans gave the bill no support, forcing Mr. Gibbons to muster 20 Democratic votes for every measure. To do that, the committee has retreated into closed party caucuses to thrash out each proposal -- 11 hours on Tuesday alone -- before reappearing for public votes. It is in these private sessions, her colleagues say, that Mrs. Kennelly's personal and political skills have been most apparent.

Some Victories

She won on several fine points. When Representative Richard E. Neal, Democrat of Massachusetts, proposed lowering to 100 employees the threshold at which companies would be allowed to insure themselves, Mrs. Kennelly argued successfully that such companies should also be allowed to buy private insurance based on an "experience rating" of their claims, rather than a broad community rating. If such employers had to pay rates based on an entire community's risk, she contended, they would have strong incentives to insure themselves, leaving private insurers to compete for only the sickest, most risky populations.

Mrs. Kennelly, who will turn 58 on July 10, also secured a provision that would allow mammograms every year for women over 65, instead of one every other year. The original bill called for annual tests only for women between the ages of 50 and 65. "I said, 'I need this one,' " she recalled, noting the increased risks of breast cancer for older women.

Born to Politics

"Her father must have injected her and her mother must have fed her political milk," said former Representative Geraldine A. Ferraro, one of her old friends, "because she really has this sixth sense. Obviously, she's going to be concerned about how something affects her district, but she looks at the bigger picture."

Indeed, Mrs. Kennelly has been surrounded by politicians her whole life. Her father was John Bailey, the legendary Connecticut Democratic boss and chairman of the Democratic National Committee under Presidents John F. Kennedy and Lyndon B. Johnson. She is married to James J. Kennelly, a former Speaker of the Connecticut House. Her first political job was as a member of the Hartford City Council, and she went on to become Secretary of State for Connecticut, bucking the party's pick to win the nomination and then an easy general election. She won her House seat in a special election in 1981, after the death of the longtime incumbent.

Mrs. Kennelly speaks quickly but quietly. Even in a casual conversation, she refers to her colleagues with exquisite but unforced formality as "Mrs. Johnson" and "Dr. McDermott." She was the first woman on the House Intelligence Committee and is now the senior woman on Ways and Means, and she was picked by Speaker Thomas S. Foley as a chief deputy whip in 1991. She has often been touted as a potential candidate for Governor of Connecticut, but she decided last fall to pass up the chance. Next year, she will run for vice chairman of the Democratic caucus, but she laughingly deflected questions about that, saying members have other things on their minds.

"She's in a special spot" because of pressures in her district, said a committee colleague, Charles B. Rangel of Manhattan. "She has been courageous and strong, and won and deserves the respect of the group."

Mrs. Kennelly put it tersely: "You're never going to make everybody happy. That's how I've kept the respect of the committee. They know I won't be a flack without policy reasons."

Photo: The economy of the Hartford district that sends RepresentativeBarbara B. Kennelly, Democrat of Connecticut, to Congress depends heavily on the insurance industry. But Mrs. Kennelly, the highest-ranking woman in the House, has voted repeatedly for health insurance changes that are likely to anger some constituents, even as she has pushed for changes that will protect insurance companies. (Karin Anderson for The New York Times) Chart: "DIARY: Health Care Developments" YESTERDAY CONGRESS The House The Ways and Means Committee, the most influential House committee in the health care debate, passed a measure meeting President Clinton's goal of universal coverage and requiring employers to pay most of the cost of insuring their workers. But the margin of victory was slim, 20-18, and strictly along party lines, suggesting that passage of a similar measure in the full House would require party discipline it will be difficult for Democrats to maintain. Republicans engineered a vote on Clinton's original 1,342-page Health Security Act. After an occasionally angry debate, 19 Democrats voted present; 3 Democrats and all 14 Republicans voted no. The Senate In a blow to the White House, the Finance Committee rejected a plan proposed by its chairman, Senator Daniel Patrick Moynihan of New York, that would have required employers to provide coverage to workers if changes in insurance regulations did not produce universal coverage by 1999. Instead, it adopted by a vote of 12-8, a proposal to let a National Health Commission recommend remedies to Congress if 95 percent of Americans are not insured by 2002. The plan would seek to force Congress to vote on any recommendations. On this issue and on others, the committee reluctantly followed proposals made Friday by a bipartisan group headed by Senator John H. Chafee, a Rhode Island Republican, and John B. Breaux, a Louisiana Democrat. The White House President Clinton called the Ways and Means Committee's action "a giant stride forward." He attacked a proposal by Senator Bob Dole, the Republican leader, that would alter insurance regulation and offer some subsidies to make insurance easier to obtain and more affordable for the very poor. Mr. Dole's proposal, supported by 39 of the 44 Senate Republicans, "is politics as usual," Mr. Clinton said today.